Positive end‐expiratory pressure titration at bedside using electrical impedance tomography in post‐operative cardiac surgery patients

Karsten, Jan; Grusnick, C.; Paarmann, Hauke; Heringlake, Matthias; Heinze, Hermann

doi:10.1111/aas.12518

Cited by 44 publications

(32 citation statements)

References 27 publications

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“…These measures have most often been derived from the decremental PEEP-titration manoeuvre. [73][74][75] Figure 3 shows an example patient examination during this manoeuvre. By sequentially measuring the EIT-derived regional C rs , it is possible to quantify the amounts of tissue that (a) recollapse during the trial, excluding them from ventilation and (b) are brought back to adequate ventilation, previously impaired by hyperdistension.…”

Section: Monitoring Of Mechanical Ventilationmentioning

confidence: 99%

Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the TRanslational EIT developmeNt stuDy group

Frerichs¹,

Amato

Kaam

et al. 2016

Thorax

687

719

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Electrical impedance tomography (EIT) has undergone 30 years of development. Functional chest examinations with this technology are considered clinically relevant, especially for monitoring regional lung ventilation in mechanically ventilated patients and for regional pulmonary function testing in patients with chronic lung diseases. As EIT becomes an established medical technology, it requires consensus examination, nomenclature, data analysis and interpretation schemes. Such consensus is needed to compare, understand and reproduce study findings from and among different research groups, to enable large clinical trials and, ultimately, routine clinical use. Recommendations of how EIT findings can be applied to generate diagnoses and impact clinical decision-making and therapy planning are required. This consensus paper was prepared by an international working group, collaborating on the clinical promotion of EIT called TRanslational EIT developmeNt stuDy group. It addresses the stated needs by providing (1) a new classification of core processes involved in chest EIT examinations and data analysis, (2) focus on clinical applications with structured reviews and outlooks (separately for adult and neonatal/paediatric patients), (3) a structured framework to categorise and understand the relationships among analysis approaches and their clinical roles, (4) consensus, unified terminology with clinical user-friendly definitions and explanations, (5) a review of all major work in thoracic EIT and (6) recommendations for future development (193 pages of online supplements systematically linked with the chief sections of the main document). We expect this information to be useful for clinicians and researchers working with EIT, as well as for industry producers of this technology.

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Section: Monitoring Of Mechanical Ventilationmentioning

confidence: 99%

Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the TRanslational EIT developmeNt stuDy group

Frerichs¹,

Amato

Kaam

et al. 2016

Thorax

687

719

View full text Add to dashboard Cite

show abstract

“…It is been previously confirmed that ideal levels of PEEP may minimize the risk of ventilator-associated lung injury, thus reduce the duration of mechanical ventilation and ICU stay (Karsten et al 2015). Out study introduced a non-invasive measure to help select an ideal PEEP to achieve better outcomes without causing severe side effects in cardiovascular system.…”

Section: Discussionmentioning

confidence: 93%

Pleth variability index and respiratory system compliance to direct PEEP settings in mechanically ventilated patients, an exploratory study

Zhou

Han

2016

SpringerPlus

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ObjectivesTo analyze the ability of pleth variability index (PVI) and respiratory system compliance (RSC) on evaluating the hemodynamic and respiratory effects of positive end expiratory pressure (PEEP), then to direct PEEP settings in mechanically ventilated critical patients.MethodsWe studied 22 mechanically ventilated critical patients in the intensive care unit. Patients were monitored with classical monitor and a pulse co-oximeter, with pulse sensors attached to patients’ index fingers. Hemodynamic data [heart rate (HR), perfusion index (PI), PVI, central venous pressure (CVP), mean arterial pressure (MAP), peripheral blood oxygen saturation (SPO2), peripheral blood oxygen content (SPOC) and peripheral blood hemoglobin (SPHB)] as well as the respiratory data [respiratory rate (RR), tidal volume (VT), RSC and controlled airway pressure] were recorded for 15 min each at 3 different levels of PEEP (0, 5 and 10 cmH2O).ResultsDifferent levels of PEEP (0, 5 and 10 cmH2O) had no obvious effect on RR, HR, MAP, SPO2 and SPOC. However, 10 cmH2O PEEP induced significant hemodynamic disturbances, including decreases of PI, and increases of both PVI and CVP. Meanwhile, 5 cmH2O PEEP induced no significant changes on hemodynamics such as CVP, PI and PVI, but improved the RSC.ConclusionsRSC and PVI may be useful in detecting the hemodynamic and respiratory effects of PEEP, thus may help clinicians individualize PEEP settings in mechanically ventilated patients.

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“…At this time there are different views on the matter. Lachmann introduced the “open lung concept” applying higher levels of PEEP to keep the lungs open while others focus their ventilator settings on avoiding overdistension secondary to high PEEP levels, or define optimal PEEP as the lowest level of alveolar overdistension and collapse [19–22]. The PEEP level using a more open lung approach with CL less than 3 or 1% are presented as supplementary material.…”

Section: Discussionmentioning

confidence: 99%

“…Optimal PEEP was determined as the best compromise between alveolar overdistension and alveolar collapse by off-line analysis of changes in regional compliance during each PEEP step in the decremental part of the PEEP trial. This means the best regional compliance to maximize recruitment of the dependent lung and minimize overdistension of nondependent lung areas [18, 19] (Fig. 2).…”

Section: Methodsmentioning

confidence: 99%

Clinical implementation of electric impedance tomography in the treatment of ARDS: a single centre experience

Heines

Strauch

Poll

et al. 2018

J Clin Monit Comput

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To report on our clinical experience using EIT in individualized PEEP titration in ARDS. Using EIT assessment, we optimized PEEP settings in 39 ARDS patients. The EIT PEEP settings were compared with the physicians' PEEP settings and the PEEP settings according to the ARDS network. We defined a PEEP difference equal to or greater than 4 cm HO as clinically relevant. Changes in lung compliance and PaO/FiO-ratio were compared in patients with EIT-based PEEP adjustments and in patients with unaltered PEEP. In 28% of the patients, the difference in EIT-based PEEP and physician-PEEP was clinically relevant; in 36%, EIT-based PEEP and physician-PEEP were equal. The EIT-based PEEP disagreed with the PEEP settings according to the ARDS network. Adjusting PEEP based upon EIT led to a rapid increase in lung compliance and PaO/FiO-ratio. However, this increase was also observed in the group where the PEEP difference was less than 4 cm HO. We hypothesize that this can be attributed to the alveolar recruitment during the PEEP trial. EIT based individual PEEP setting appears to be a promising method to optimize PEEP in ARDS patients. The clinical impact, however, remains to be established.

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Positive end‐expiratory pressure titration at bedside using electrical impedance tomography in post‐operative cardiac surgery patients

Cited by 44 publications

References 27 publications

Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the TRanslational EIT developmeNt stuDy group

Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the TRanslational EIT developmeNt stuDy group

Pleth variability index and respiratory system compliance to direct PEEP settings in mechanically ventilated patients, an exploratory study

Clinical implementation of electric impedance tomography in the treatment of ARDS: a single centre experience

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